Health and Social Care Bill

Baroness Whitaker Excerpts

Tuesday 11th October 2011 Lords Chamber

[Baroness Whitaker]

My Lords, it is always a pleasure to follow the noble Lord, Lord Crisp, after his broad sweep. I want to focus on two much narrower areas, which do not seem well served by this Bill. The first is mental health, and I declare an interest as a former member of the Tavistock and Portman NHS Trust. It is fair to say that mental health has always been underfunded, considering its importance to our general health, so eloquently described by the noble Baroness, Lady Hollins, and its importance to our well-being and the economy. Old people in particular seem to be rather left out of the reckoning. I believe that the National Service Framework for Mental Health applies only to people below 65. This is odd when you think where dementia strikes most.

Professor Lewis Wolpert, in his illuminating book, You're Looking Very Well, says that fewer than 10 per cent of older people with clinical depression are referred to specialist mental health services. Some 40 per cent of those in care homes have been reported to be depressed. Indeed, more than 2 million older people over 65 have symptoms of depression; but according to Age Concern the vast majority are denied help. Would independent provision of these unpopular specialisms have any traction on this huge lack of capacity? How can this Bill prevent such ageism?

I am also aware of long waits for basic assessment; even when people have attempted suicide, three months is not uncommon. Waiting lists for this significant area of health are not being kept low, as David Cameron promised. How does the Bill improve this dangerous delay?

To focus down to the Tavistock’s own part of London, wholesale reorganisation of treatment capacity, perhaps more properly called elimination, is already having an adverse effect on patient care; some in-patients have been transferred far away from their families, while some small and valued local centres, like the Camden Psychotherapy Unit, have fallen foul of changes in council tendering criteria and suddenly have no funding. The CPU treats 90 patients a year, many of them vulnerable and socially deprived. They will lose their local service. These are not people who can always easily travel, and clinical excellence has lost out to larger, apparently more commercially attractive providers. I think that the Bill allows centres to close without public consultation, so will this problem become more widespread? What assurances have we that there will be the wish or the capacity to commission mental health services to the extent necessary?

The second area of concern to me is speech therapy, another field of supreme importance to our ability to go about our lives. I speak as a patron of the British Stammering Association and, indeed, as a long-term practitioner of stammering. But there are, of course, very much more severe communication problems than stammering, as a consequence of stroke, cancer, brain injury, learning difficulties and hearing impairment, which effectively impede relationships, proper education and employability.

I am grateful to the Communication Trust for the following disturbing figures. My noble friend Lady Wilkins had some more. Over 1 million children have speech, language or communication needs not caused by external factors such as language neglect or having English as an additional language—that is two or three in the average class. Over a quarter of all statemented children at primary level have specific language impairment needs as their primary need. It is the most common disability in childhood. Communication difficulties are common in young offenders, looked-after children and those who have conduct disorders and other behavioural difficulties. Alleviating the communication problems has a dramatic effect. The noble Lord, Lord Ramsbotham, referred to this. It really matters to intervene early if these children are to be given anything like a fair chance in life. GPs do not tend to refer early enough in the case of stammering, which is a very intractable disability, and they do not always know enough to realise what needs to be done. Only 9 per cent of childhood referrals come from GPs. Other health workers tend to refer earlier, and more effectively. Commissioning is at present complex and fragmented, so there is a very good case for speech, language and communication needs to come within public health. Can the Minister tell me whether this is the case? Does he recognise the importance of integrated commissioning for speech, language and communication services, not just within the health sector, but also between health and education commissioners, to which my noble friend Lady Wilkins also drew attention?

There are risks in the proposal to split responsibility for the commissioning of children’s public health services, with the NHS Commissioning Board responsible from the mother’s pregnancy to five years, and local authorities for five to 19 year-olds. So what role will the health and well-being boards play in ensuring effective and co-ordinated commissioning of children’s services, and can the Minister confirm whether the boards will be encouraged to consider pooled budgets and joint commissioning arrangements for speech therapy services for children?